DANIEL TAVARES DE REZENDE
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- Peroral endoscopic myotomy (POEM): a comparative study between Chagasic and idiopathic achalasia(2020) FARIAS, Galileu F. A.; MOURA, Diogo T. H. de; MOURA, Eduardo T. H. de; REZENDE, Daniel T. de; HATHORN, Kelly E.; NASI, Ary; QUEIROZ, Natalia S. F.; MOURA, Eduardo G. H. deBackground and study aims Achalasia can be classified as either primary (idiopathic) achalasia or secondary achalasia, which is a consequence of another systemic disease. Peroral endoscopic myotomy (POEM) is an effective and safe treatment for achalasia. We evaluated the efficacy and safety of POEM in patients with Chagasic achalasia compared to idiopathic achalasia. Patients and methods We evaluated POEM procedures performed at a single institution from November 2016 to January 2018. Demographic data, Eckardt score, lower esophageal sphincter (LES) pressure, body mass index, post-operative erosive esophagitis, adverse events, length of hospital stay, and procedure-related parameters were analyzed. Results Fifty-one patients underwent POEM as a treatment for achalasia in this period (20 patients with Chagasic and 31 with Idiopathic etiology). The overall clinical success rate was 92.1 %, with no statistical difference between groups (90 % in the Chagasic group vs. 93.5 % in the Idiopathic group, P = 0.640). Both groups had significant reduction in Eckardt score and in LES pressure, and increase in bodey mass index (BMI) at 1-year follow-up. There was no statistical difference between groups regarding Eckardt score ( P = 0.439), LES pressure (p = 0.507), BMI ( P = 0.254), post erosive esophagitis (35 % vs. 38.7 %, P = 0.789), adverse events (30 % vs. 12 %, P = 0.163,) length of hospital stay (3.75 days vs. 3.58 days, P = 0.622), and operative time (101.3 min vs. 99.1 min, P = 0.840). Conclusion POEM is an effective and safe treatment for patients with achalasia. There is no difference in POEM outcomes for those patients with Chagasic or Idiopathic achalasia.
- ENDOSCOPIC FINDINGS IN SEVERE YELLOW FEVER PATIENTS PRESENTING WITH ACUTE UPPER GASTROINTESTINAL BLEEDING: A RETROSPECTIVE CASE SERIES STUDY(2019) GALETTI, Facundo; FARIAS, Galileu F.; MARTINS, Rafael K.; CORONEL, Martin A.; REZENDE, Daniel T.; ROCHA, Rodrigo S.; MOURA, Diogo T. de; BRUNALDI, Vitor O.; HO, Yeh-Li; BABA, Elisa; MOURA, Eduardo G. de
- Endoscopic dual therapy for giant peptic ulcer hemorrhage(2018) RIBEIRO, Igor Braga; REZENDE, Daniel Tavares; MADRUGA NETO, Antonio Coutinho; IDE, Edson; FURUYA, Carlos Kiyoshi; MOURA, Diogo Turiani Hourneaux De; MOURA, Eduardo Guimaraes Hourneaux De
- Argon plasma coatmlation alone versus argon plasma coagulation plus full-thickness endoscopic suturing to treat weight regain after Roux-en-Y gastric bypass: a prospective randomized trial (with videos)(2020) BRUNALDI, Vitor Ottoboni; FARIAS, Galileu Ferreira Ayala; REZENDE, Daniel Tavares de; CAIRO-NUNES, Gabriel; RICCIOPPO, Daniel; MOURA, Diogo Turiani Hourneaux de; SANTO, Marco Aurelio; MOURA, Eduardo Guimaraes Hourneaux deBackground and Aims: A significant number of patients regain weight after Roux-en-Y gastric bypass. Ablation with argon plasma coagulation (APC) plus endoscopic full-thickness suturing (FTS-APC) and ablation alone have been reported for treating weight regain when associated with gastrojejunostomy (GJ) dilation. However, comparative controlled data are still lacking. Methods: This was a pilot single-center open-label randomized trial comparing the effectiveness and safety of APC alone versus FTS-APC for transoral outlet reduction. Patients with at least 20% weight regain from the nadir, and GJ >= 15 mm were considered eligible. The primary outcome was percentage total weight loss (%TWL) at 12 months. Secondary outcomes were the incidence of adverse events, amelioration of metabolic laboratory parameters, and improvement in quality of life and eating behavior. Results: Forty patients meeting the eligibility criteria were enrolled from October 2017 to July 2018. Technical and clinical success rates were similar between the groups. At 12 months, the mean %TWL was 8.3% +/- 5.5% in the APC alone group versus 7.5% +/- 7.7% in the Fl S-APC group (P = .71). The pre-revisional % solid gastric retention at 1 hour positively correlated with the probability of achieving >= 10% TWL at 12 months. Both groups experienced significant reductions in low-density lipoprotein and triglyceride levels at 12 months, and improvement in eating behavior and quality of life at 3 months. There were 2 cases of stenoses (1 from each group), which were successfully treated with endoscopic balloon dilation. Conclusion: APC alone is similar to FTS-APC in terms of technical and clinical outcomes within 1 year of followup.
- FULL-THICKNESS ENDOSCOPIC SUTURING PLUS APC VERSUS APC ALONE TO TREAT WEIGHT REGAIN FOLLOWING ROUX-EN-Y GASTRIC BYPASS: AN INTERIM ANALYSIS OF A RANDOMIZED CONTROLLED TRIAL(2019) BRUNALDI, Vitor O.; FARIAS, Galileu F.; REZENDE, Daniel T.; NUNES, Gabriel C.; MOURA, Diogo T. de; NETO, Manoel Galvao; SOUZA, Thiago F.; RICCIOPPO, Daniel; SANTO, Marco Aurelio; MOURA, Eduardo G. de
- PERORAL ENDOSCOPIC MYOTOMY (POEM): A COMPARATIVE STUDY BETWEEN CHAGASIC AND IDIOPATHIC ACHALASIA(2019) FARIAS, Galileu F.; MOURA, Eduardo T.; MOURA, Diogo T. de; BRUNALDI, Vitor O.; REZENDE, Daniel T.; GALETTI, Facundo; QUEIROZ, Natalia S.; NASI, Ary; SALLUM, Rubens A.; SAKAI, Paulo; MOURA, Eduardo G. de
- Use of hemostatic powder in treatment of upper gastrointestinal bleeding: a systematic review and meta-analysis(2019) REZENDE, Daniel Tavares de; BRUNALDI, Vitor Ottoboni; BERNARDO, Wanderley Marques; RIBEIRO, Igor Braga; MOTA, Raquel Cristina Lins; BARACAT, Felipe Iankelevich; MOURA, Diogo Turiani Hourneaux de; BARACAT, Renato; MATUGUMA, Sergio Eiji; MOURA, Eduardo Guimaraes Hourneaux deBackground and study aims TC-325 is a novel mineral hemostatic powder that creates a mechanical barrier by absorbing blood components and promoting clotting. Recently approved for use in humans, it has shown promise for treatment of upper gastrointestinal bleeding (UGIB). However, because there have been no large studies of TC-325, its true efficacy and safety profile remain unknown. We performed a systematic review and meta-analysis to determine the safety and efficacy of TC-325 in treating UGIB, based on rates of initial hemostasis, rebleeding, and adverse events (AEs). Methods We searched the MEDLINE/PubMed, EMBASE, CENTRAL, Latin-American and Caribbean Health Sciences Literature databases, as well as the gray literature, to identify articles describing use of TC-325 up to October 2018.Primary outcomes were initial hemostasis and rebleeding. AEs were described as a secondary outcome. Risk of bias was assessed with international scores. Results We identified 2077 records after removal of duplicates. We included 50 studies, involving a collective total of 1445 patients, in the quantitative synthesis. Primary hemostasis and rebleeding rates were 90.7% and 26.1%, respectively. Subgroup analyses showed similar results. Only eight AEs were reported. Conclusions TC-325 appears to be a safe, effective treatment for UGIB. The overall rate of initial hemostasis after TC-325 use is high, regardless of etiology of bleeding or whether TC-325 is used as a primary or rescue therapy. Although it is also associated with high rebleeding rates, rates of AEs and equipment failure after TC-325 use are extremely low.
- Adverse events after biliary sphincterotomy: Does the electric current mode make a difference? A systematic review and meta-analysis of randomized controlled trials(2020) FUNARI, Mateus Pereira; RIBEIRO, Igor Braga; MOURA, Diogo Turiani Hourneaux de; BERNARDO, Wanderley Marques; BRUNALDI, Vitor Ottoboni; REZENDE, Daniel Tavares; RESENDE, Ricardo Hannum; MARCO, Michele Oliveira de; FRANZINI, Tomazo Antonio Prince; MOURA, Eduardo Guimaraes Hourneaux deBackground: Biliary sphincterotomy is an invasive method that allows access to the bile ducts, however, this procedure is not exempt of complications. Studies in the literature indicate that the mode of electric current used for sphincterotomy may carry different incidences of adverse events such as pancreatitis, hemorrhage, perforation, and cholangitis. Aim: To evaluate the safety of different modes of electrical current during biliary sphincterotomy based on incidence of adverse events. Methods: We searched articles for this systematic review in Medline, EMBASE, Central Cochrane, Lilacs, and gray literature from inception to September 2019. Data from studies describing different types of electric current were meta-analyzed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The following electric current modalities were evaluated: endocut, blend, pure cut, pure cut followed by blend, monopolar, and bipolar. Results: A total of 1791 patients from 11 randomized clinical trials evaluating the following comparisons: 1. Endocut vs Blend: No statistical difference in the incidence of bleeding (7% vs 13.4%; RD: -0.11 [-0.31, 0.08], P=0.27, I-2=86%), pancreatitis (4.4% vs 3.5%; RD: 0.01 [-0.03, 0.04], P=0.62, I-2=48%) and perforation (absence of cases in both arms). 2. Endocut vs Pure cut: Higher incidence of mild bleeding (without drop in hemoglobin levels, clinical repercussion or need for endoscopic intervention) in the pure cut group (9.2% vs 28.8%; RD: -0.19 [-0.27, -0.12], P<0.00001, I-2=0%). No statistical difference regarding pancreatitis (5.2% vs 0.9%; RD: 0.05 [-0.01, 0.11], P=0.12, I-2=57%), perforation (0.4% vs 0%; RD: 0.00 [-0.01, 0.02], P=0.7, I-2=0%) or cholangitis (1.8% vs 3.2%; RD: -0.01 [-0.09, 0.06], P=0,7). 3. Pure cut vs blend: higher incidence of mild bleeding in the pure cut group (40.4% vs 16.7%; RD: 0.24 [0.15, 0.33], P<0.00001, I-2=0%). No statistical difference concerning incidence of pancreatitis or cholangitis. 4. Pure cut vs Pure cut followed by Blend: No statistical difference regarding incidence of bleeding (22.5% vs 11.7%; RD: -0.10 [-0.24, 0.04], P=0.18, I-2=61%) and pancreatitis (8.9% vs 14.8%; RD 0.06 [-0.02, 0.13], P=0.12, I-2=0%). 5. Blend vs pure cut followed by blend: no statistical difference regarding incidence of bleeding and pancreatitis (11.3% vs 10.4%; RD -0.01 [-0.11, 0.09], P=0.82, I-2=0%). 6. Monopolar vs bipolar: higher incidence of pancreatitis in the monopolar mode group (12% vs 0%; RD 0.12 [0.02, 0.22], P=0.01). Conclusion: Pure cut carries higher incidences of mild bleeding compared to endocut and blend. However, this modality might present a lower incidence of pancreatitis. The monopolar mode elicits higher rates of pancreatitis in comparison with the bipolar mode. There is no difference in incidence of cholangitis or perforation between different types of electric current. There is a lack of evidence in the literature to recommend one method over the others, therefore new studies are warranted. As there is no perfect electric current mode, the choice in clinical practice must be based on the patient risk factors.